Provider Demographics
NPI:1578630760
Name:NELSON, TAMI (DC)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2133
Mailing Address - Country:US
Mailing Address - Phone:413-786-4820
Mailing Address - Fax:413-786-7003
Practice Address - Street 1:546 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2133
Practice Address - Country:US
Practice Address - Phone:413-786-4820
Practice Address - Fax:413-786-7003
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36223Medicare ID - Type Unspecified